Kerato-lenticular ocular deposits and visual impairment with prolonged chlorpromazine use: A case series

Possible involvement of apoptosis in the antipsychotics side effects: A minireview

Antipsychotics are used in the treatment of schizophrenia and other psychiatric disorders. Generally they are divided into typical and atypical ones, according to the fact that atypical antipychotics induce less side effects and are more effective in terms of social and cognitive improvements. Their pharmacological effects are mediated via broad range of receptors that consequently influence different cellular signaling pathways. Antipsychotics produce udesirable side effects that range from relatively minor to life-threatening ones. In vitro and in vivo studies have pointed to neurotoxic effect exerted by some antipsychotics and have shown that apoptosis might play role in some side effects induced by antipsyschotics, including tardive dyskinesia, weight gain, agranulocytosis, osteoporosis, myocarditis, etc. Although cumulative data have suggested safety of atypical antipsychotics use during pregnancy some of them have been shown to induce apoptotic neurodegenerative and structural changes in fetal brains with long-lasting impact on cognitive impairment of offsprings. Typical antipsychotics seem to be more cytotoxic than atypical ones. Recently, epidemiological studies have shown lower incidence of cancer in schizophrenic patients what suggest ability of antipsychotics to suppress risk of cancer development. Some antipsychotics have been reported to inhibit cancer cell proliferation and induce their apoptosis. Thus, antipsychotics apoptotic effect may be used as a tool in the treatmnet of some types of cancer, especially in combinatorial therapies. In this minireview, we focused on pro- and anti-apototic or "Dr. Jekyll and Mr. Hyde" effects of antipsychotics, which can be involved in their side effects, as well as their promising therapeutical indications. This article is protected by copyright. All rights reserved.

Light and electron microscopy of chlorpromazine-induced hyperpigmentation

Chlorpromazine may induce abnormal skin hyperpigmentation in exposed areas, described as slate-gray, purple, or blue-grayish discoloration. A 58-year-old man with schizophrenia, had been taking chlorpromazine for 5 years, and his sun-exposed skin areas exhibited a blue-grayish color. Large deposits of brown pigment and granular basophilic material were seen in the dermis with light microscopy. HMB-45 and anti-Melan-A antibody immunostaining labeled some pigment in the dermis. Transmission electron microscopy identified deposits among dermal collagen bundles collagen in both transverse and longitudinal sections. In the latter, an arboriform aspect of deposits was quite clear, and some melanophages were also seen. The three-dimensional examination of the dermis with scanning electron microscopy also identified deposits, which at higher magnification demonstrated an appearance in the shape of leaves, grass-like, interspersed with normal collagen. These results suggest a complex pathogenic mechanism, including deposition of dermal melanin together with drug itself and potentially additional unknown metabolites.